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With over 40 carriers who work with us, we have the tools to find the right coverage for your needs. You trust us with all your financial needs, and you can also trust us to protect everything in your life.

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Life Insurance

Life insurance can help your family pay the bills, even if you aren’t here. Go online or give us a call to start planning now.

Coverage Amout

Length of Term

State

Gender

Male

Female

Height

Weight (LBS)

Date of Birth

Have you used tobacco products?

Have any of your immediate family members (parent or siblings) died from cancer, diabetes, heart or kidney disease or stroke prior to their age 60?

Yes

No

Have you ever been diagnosed with or treated for depression, anxiety or any psychological disorder, asthma, ulcerative colitis or rheumatoid arthritis?

Yes

No

Have you been diagnosed or treated for any of the following: heart or coronary artery disease, stroke, cancer, diabetes, hepatitis, cirrhosis, emphysema or chronic lung or pulmonary disease (COLD or COPD), alcohol or drug abuse?

Yes

No

First Name

Last Name

Email Address

Phone Number

Member Number

Referred by

Happy Birthday

Having trouble? Please call and we can assist.

The person listed on this form is consenting to receive phone calls from The Life Insurance Center, a division of InsureNOW Direct for marketing products and services, at the phone number(s) listed, including a wireless number if provided. You understand these calls may be generated using an automated technology. Consent is not required to purchase - call The Life Insurance Center, a division of InsureNOW Direct to purchase without consent.

Insurance products are not insured by NCUA or any Federal Government Agency; are not a deposit of, or guaranteed by the Credit Union or any Credit Union Affiliate; and may lose value. Any insurance required as a condition of the extension of credit by Oregon State Credit Union need not be purchased from our Agency but may, without affecting the approval of the application for an extension of credit, be purchased from an agent or insurance company of the customer's choice.